Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1114586427 |
---|---|
Provider Name | Ms. Misty Autumn Brown |
First Address | Shippensburg, PA 17257-9340 |
Second Address | Shippensburg, PA 17257-9340 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2019 |
Last Update Date | 10/06/2019 |